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			<h3>American Metric 电子产品调查表</h3>
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			<form action="#" method="get">
				<p><label for="nm">姓名：</label><input type="text" name="name" id="nm" required="required" placeholder="输入必须是2-6位字符" /></p>
				<p>购买日期：<input name="Year" type="number" max="2017" min="1998" required="required" id="Y" /><label for="Y">年</label>
					<select name="Month" id="M" required="required">
						<option value="一月">1月</option>
						<option value="二月">2月</option>
						<option value="三月">3月</option>
						<option value="四月">4月</option>
						<option value="五月">5月</option>
						<option value="六月">6月</option>
						<option value="七月">7月</option>
						<option value="八月">8月</option>
						<option value="九月">9月</option>
						<option value="十月">10月</option>
						<option value="十一月">11月</option>
						<option value="十二月">12月</option>

					</select><label for="M">月</label>
					<select name="Day" id="D" required="required">
						<option value="1">01</option>
						<option value="2">02</option>
						<option value="3">03</option>
						<option value="4">04</option>
						<option value="5">05</option>
						<option value="6">06</option>
						<option value="7">07</option>
						<option value="8">08</option>
						<option value="9">09</option>
						<option value="10">10</option>
						<option value="11">11</option>
						<option value="12">12</option>
						<option value="13">13</option>
						<option value="14">14</option>
						<option value="15">15</option>
						<option value="16">16</option>
						<option value="17">17</option>
						<option value="18">18</option>
						<option value="19">19</option>
						<option value="20">20</option>
						<option value="21">21</option>
						<option value="22">22</option>
						<option value="23">23</option>
						<option value="24">24</option>
						<option value="25">25</option>
						<option value="26">26</option>
						<option value="27">27</option>
						<option value="28">28</option>
						<option value="29">29</option>
						<option value="30">30</option>
						<option value="31">31</option>
					</select><label for="D">日</label>
				</p>
			<p><label for="em">电子邮件地址：</label><input name="Email" type="email" id="em" required="required" placeholder="格式是xxx.@XX.com" /></p>
		<p><label for="tel">手机号码：</label><input name="TelNo" type="tel" id="tel" required="required" placeholder="输入必须是13|15|18为开头的11位数字" /></p>
			<p>您是否查看过我们的在线产品目录：<input name="SeeOnlinPROList" type="radio" id="ye" required="required" value="Y" checked="checked" /><label for="ye">是</label>
			<input name="SeeOnlinPROList" type="radio" id="no" required="required" value="N" /><label for="no">否</label></p>
			<p>如果查看过，您对哪些产品有兴趣购买？（选择提供的产品）<br/>
				<input type="checkbox" id="television" name="buy"  value="television" /><label for="television">大屏幕电视机</label>
			<input type="checkbox" id="audio" name="buy" value="audio"/><label for="audio">音频设备</label>
			<input type="checkbox" id="video" name="buy" value="video" /><label for="video">视频设备</label>
			<input type="checkbox" id="camera" name="buy" value="camera" /><label for="camera">相机</label>
			</p>
			<p><label for="textarea">在填写订单之前，你还有什么问题、意见或建议？</label><br/>
				<textarea id="textarea" name="textarea" rows="4" cols="40" required>你的输入：</textarea>
			</p>
			<p><input type="submit" value="提交" /><input type="reset" value="重置" disabled="disabled" /></p>
			</form>
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